Sometimes we take the supply of clean running water for granted. But for many people in the world, shortages of clean water create hygiene problems and in some cases lead to blindness.
Trachoma is one of this and the oldest known diseases and leading infectious cause of blindness in the world. The Fred Hollows Foundation spoke with Dr Wondu Alemayehu, its technical advisor in Ethiopia, to find out how water is related to outbreak of trachoma.
FHF – The Fred Hollows Foundation
Dr Wondu Alemayehu - WA

FHF︰Where is trachoma still active?

WA︰Africa is the most affected continent but trachoma is actually a public health problem in 41 countries worldwide. It is responsible for the blindness or visual impairment of about 1.9 million people globally.
FHF︰What environmental conditions place people at risk of trachoma infection?
WA︰The disease thrives in crowded living conditions where there are shortages of water, inadequate sanitation and where lots of eye-seeking flies are present. Trachoma is endemic in Ethiopia, particularly in Oromia, its largest regional state.

FHF︰Why are children and women vulnerable to trachoma?
WA︰Trachoma affects the most vulnerable and disadvantaged in the communities – mothers and children. While children are the main people infected, the risk of developing blinding trichiasis increases with age. This affects women and mothers disproportionately we think because of their increased contact with children as primary care givers.
In addition, scarcity of water and the very nature of the disease, with preschool children being most infected, make it even more difficult.
These children, with minimal symptoms, are totally dependent on care takers for personal hygiene. Un-empowered, busy mothers who shoulder compounded responsibilities and chores, are unable to prioritise this responsibility.
FHF︰Trachoma is a 'neglected tropical disease' (NTD). Why is it neglected considering the numbers of people affected?

WA︰It's an NTD because it's largely a silent disease in its acute and active stages and its blinding, painful and detrimental end stage disproportionately affects women and mothers living in challenged countries as well as mainly hard to reach areas. There is a huge lack of awareness and gender disparity.
Furthermore, it's wrongly perceived as a ‘non-killer’ disease by decision makers in many of these countries.
The fact that these same countries are faced with other huge competing demands such as tuberculosis, malaria, HIV and so on, is also a formidable challenge, making trachoma a 'neglected tropical disease' despite its enormous detrimental consequences on individuals, their families, communities and countries at large.
FHF︰What can we do to minimize the risk of trachoma?
WA︰The Fred Hollows Foundation is part of the International Coalition for Trachoma Control, which advocates for the implementation of the World Health Organization’s SAFE strategy:
Surgery: to prevent blindness by eyelid surgery to correct inverted eyelashes
Antibiotics: community wide distribution of antibiotics to treat active infection
Face washing: to stop eye seeking flies that spread infection
Environment: to give communities access to water and improved sanitation
The F and E component is the most important. They deal with personal hygiene and environmental improvement which are key in sustainably eliminating blinding trachoma. These components involve a daunting but essential task of the development of water, sanitary facilities and bringing about behavioral change.
Face Washing and Environmental Improvement are fundamental in the achievement of the ultimate goal of The Fred Hollows Foundation, that is the elimination of blinding trachoma as a public health problem.
FHF︰Solutions are already available. Why is eliminating trachoma so difficult?
WA︰Currently, water access is one of the major challenges severely undermining hygiene practice in affected communities making the elimination effort difficult.
The Oromia region has very high but untapped water resource potential that should be effectively and efficiently utilised to tackle the trachoma problem.


FHF: If people had much greater access to clean water today, how rapidly would you see a positive change in the elimination of an NTD like trachoma?
WA︰Access to water is a highly critical input, especially to bring about behavioural change in communities, particularly mothers, to promote hygiene among the pre-school population.
This should go with utilisation, which is closely linked with the level of awareness, understanding of the disease process, and action by the community, decision makers and all other stakeholders.